| NPI | 1992781835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60528155) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-02651) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2015-08-18 |